<!DOCTYPE html>
<html >
<head>
    <meta charset="UTF-8">
    <title>老人信息管理</title>

    <link rel="stylesheet" href="/css/modules/code.css">
    <link rel="stylesheet" href="/css/modules/laydate/default/laydate.css">
    <link rel="stylesheet" href="/css/modules/layer/default/layer.css">
    <link rel="stylesheet" href="/css/layui.css">
    <link rel="stylesheet" href="/css/ipt.css">

<#include "common/common-head.html"/>
</head>

<body>
    <div class="layui-layout layui-layout-admin">
        <div class="layui-header">
            <div class="layui-logo">居家养老系统欢迎您！</div>
            <ul class="layui-nav" style="margin-left: 200px;">
                <li class="layui-nav-item"><a href="/index">老人信息输入</a></li>
                <li class="layui-nav-item"><a href="/orderDoctor">医生预约</a></li>
                <li class="layui-nav-item"><a href="/orderVol">志愿者预约</a></li>
            </ul>
        </div>
    </div>

    <div >
        <form method="post" class="layui-form" action="/elderly/add">
            <div class="layui-form-item short">
                <label class="layui-form-label">姓名</label>
                <div class="layui-input-block">
                    <input type="text" name="username" lay-verify="required" placeholder="请输入" autocomplete="off" class="layui-input">
                </div>
            </div>

            <div class="layui-form-item short">
                <label class="layui-form-label">编号</label>
                <div class="layui-input-block">
                    <input type="text" name="no" lay-verify="required" placeholder="请输入" autocomplete="off" class="layui-input">
                </div>
            </div>

            <div class="layui-form-item">
                <label class="layui-form-label">性别</label>
                <div class="layui-input-block">
                    <input type="radio" name="sex" value="男" title="男">
                    <input type="radio" name="sex" value="女" title="女" checked>
                </div>
            </div>

            <div class="layui-form-item short">
                <label class="layui-form-label">年龄</label>
                <div class="layui-input-block">
                    <input type="text" name="age" lay-verify="required" placeholder="请输入" autocomplete="off" class="layui-input">
                </div>
            </div>

            <div class="layui-form-item short ">
                <label class="layui-form-label">联系方式</label>
                <div class="layui-input-block">
                    <input type="tel" name="phone" lay-verify="required|phone" autocomplete="off"  placeholder="请输入" class="layui-input">
                </div>
            </div>

            <div class="layui-form-item long">
                <label class="layui-form-label">家庭地址</label>
                <div class="layui-input-block">
                    <input type="text" name="address" lay-verify="required" placeholder="请输入" autocomplete="off" class="layui-input">
                </div>
            </div>

            <div class="layui-form-item layui-form-text long">
                <label class="layui-form-label">过往病史/过敏史</label>
                <div class="layui-input-block">
                    <textarea name="history" placeholder="请输入内容" class="layui-textarea" lay-verify="required"></textarea>
                </div>
            </div>

            <div class="layui-form-item layui-form-text long">
                <label class="layui-form-label">当前身体状况</label>
                <div class="layui-input-block">
                    <textarea name="status" placeholder="请输入内容" class="layui-textarea" lay-verify="required"></textarea>
                </div>
            </div>

            <button id = "ipt-submit-button" type="submit"  lay-filter="demo1" class="layui-btn layui-btn-radius" lay-submit=""  style = "margin: 20px 0 0 200px">提交</button>
        </form>
    </div>

    <div style="text-align:center;">
        <p>&nbsp;</p>
    </div>
</body>

<script src="js/layui.all.js"></script>
<script src="js/jquery-3.3.1.js"></script>
<script>
    layui.use(['layer', 'form'], function(){
        var layer = layui.layer
            ,form = layui.form;


        form.render();
    });


</script>
</html>
